Cold lesions on bone scan in pediatric neoplasms

Area of Science:

• Pediatric Oncology
• Nuclear Medicine
• Radiology

Background:

• Bone scintigraphy is a common imaging technique in pediatric oncology.
• Photon-deficient (cold) lesions on bone scans are typically associated with benign processes.
• The incidence and significance of cold lesions due to malignancy in pediatric patients are not well-established.

Purpose of the Study:

• To determine the incidence of photon-deficient (cold) lesions on bone scans in pediatric oncology patients.
• To identify tumor types associated with cold lesions on bone scans.
• To describe the imaging characteristics and follow-up findings of cold lesions in this population.

Main Methods:

• Retrospective review of bone scans from 425 pediatric oncology patients.
• Analysis of lesion characteristics, associated tumor types, radiographic findings, and follow-up scan data.
• Literature review of previously reported cases of cold lesions due to tumor in pediatric patients.

Main Results:

• Eight patients (1.8%) presented with cold lesions on bone scans.
• Six tumor types were identified that had not been previously reported to cause cold lesions.
• Five of the eight patients had normal radiographs at the site of the cold lesion.
• Most patients (7/8) exhibited "hot spots" in addition to cold lesions.
• Follow-up scans showed resolution in two cases and a change from cold to hot in one case.
• Literature review identified eight prior cases, predominantly neuroblastoma and osteosarcoma.

Conclusions:

• Photon-deficient lesions on bone scans, though uncommon, can be associated with a variety of tumors in pediatric oncology patients.
• The presence of cold lesions should prompt further investigation, even with normal radiographic findings.
• These findings expand the spectrum of bone scan appearances in pediatric malignancies.